It’s clear the GOP has stalled in its drive to repeal and replace Obamacare. In fact, it’s beginning to look unlikely this objective will ever be achieved – at least not the way the voters who returned Republicans to power in Congress over the last several elections wanted.

The idea of “ripping it out by its roots,” as more than one congressional candidate on the stump promised, has been overtaken by political reality. With 60 votes needed to do almost anything in the Senate and President Obama waiting at the other end of Pennsylvania Avenue to veto a bill that undoes his signature achievement, the bar for full repeal is at the moment just too high.


Enter Rep. Kevin BradyKevin Patrick BradyConservative groups aim to sink bipartisan fix to 'surprise' medical bills Trump economic aide says new tax proposal could be unveiled this summer Hoyer: Democratic chairmen trying to bridge divide on surprise medical bills MORE, a Republican member of the House who represents a district near Houston, Texas. He’s vice chairman of the Congress’s Joint Economic Committee and chairman of the House Subcommittee on Health. As his official biography puts it he’s “a champion of free enterprise” who intends to use his leadership position on Ways and Means to “focus on ensuring a strong, free market in the nation's health care industry and look for ways to increase the quality of health care, while keeping costs low.”

Brady has ambitiously set his sights on reforming Medicare -- and his approach may be the only way to save it. His three-part plan, which has been covered extensively in the policy press by outlets like National Journal and part of which has already passed the House, includes restoring the payments made to doctors for services rendered under Medicare and reforming the system to simplify hospital payments and introduce pay for performance into post-acute care. He also plans to introduce a proposal next year to combine the currently separate Medicare Part A coverage for hospital services and Part B coverage for physician care into a single plan with a single deductible, cap out of pocket spending, and will also include what is known as “premium support” to encourage seniors to seek more personalized options.

These are big ideas – and are likely to face opposition from the rent-seekers who rely on federal largess to line their pockets. They may also, in the longer term, lead to the unravelling of the Affordable Care Act, along with other modifications that actually make the American health care system better.

Contrast that with efforts to change an obscure federal initiative to provide prescription drugs at reduced cost to hospitals that treat large numbers of poor people. 340B, a program Congress first authorized in 1992, has functioned well up to now but there’s a lot of money being spread around Washington to try and kill it or at worst rein it in.

In context it is important to note that the ACA expanded 340B eligibility to small, rural hospitals and it helps them keep their doors open and able to treat all patients, regardless of income.  The drug industry doesn’t much like 340B because it funds the program through discounts to hospitals.

While conservative stalwarts like Brady bravely tackle the vexing problems of the Medicare system, some Republicans have been wooed by Big Pharma to support gutting 340B in the name of “reform.” For a program that doesn’t cost taxpayers a dime and only represents 2 percent of the $374 billion U.S. drug market, the effort is sadly misplaced.

If 340B works as Congress intended and isn’t funded with public money, why are conservatives wasting their time trying to mess with it at the behest of large and well-funded special interests? This is not the kind of reforms the GOP was put back into congressional power to make. Instead of engaging in crony capitalism, the Republicans should spend what precious political capital they have backing Brady’s reforms to Medicare which could actually change the game in a way that benefits everybody.

Roff is a senior fellow at Frontiers of Freedom, an organization advocating for personal choice in the healthcare and other critical sectors of the American economy.